What is HSRA?

In 1999 the Philippines Department of Health took a bold step towards improving the performance of the health sector by improving the way health services are being provided and financed. This program of change, known popularly as the Health Sector Reform Agenda, are directed mainly at a) expanding effective coverage of national and local public health programs; b) increasing access, especially by the poor, to personal health services delivered by both public and private providers; and c) reducing the financial burden on individual families through universal coverage of the National Health Insurance Program (NHIP). It consists of five interrelated health reform areas:
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Local health systems development Promote the development of local health systems where networking among municipal and provincial health facilities are functional and sustained by cooperation and cost sharing among local government units (LGUs) in the catchment area. Hospital reforms Provide fiscal and managerial autonomy to government hospitals, which involves improving the way hospitals are governed and financed so that quality of care is improved, hospital operations are cost efficient, revenues are enhanced and retained, and dependence on direct budget subsidies are reduced. Public health program reforms Strengthen the capacity of the DOH to exercise technical leadership in disease prevention and control; enhance the effectiveness of local public health delivery systems; and sustain funding for priority public health programs over a period required to remove them as public health threats. Health regulatory reforms Strengthen capacities of DOH to exercise its regulatory functions to ensure that health products (particularly pharmaceuticals), devices, and facilities are safe, affordable, and of good quality. Social health insurance reforms Expand the coverage and enhance the benefit package of NHIP so as to effectively reduce the financial burden to individual families through effective risk pooling, and provide the NHIP greater leverage to ensure value for money in benefit spending.

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The HSRA was designed to be implemented as a package because the components are highly interdependent. The implementation strategy adopted by the DOH was to gradually implement the reform package in selected implementation or convergence sites. These sites (a province or a city) are called convergence sites not only because all the five major health reform components are being implemented in an integrated fashion, but also because all the major stakeholders such as the DOH, PhilHealth, the local government, civil society groups, and the beneficiaries themselves come together and pool their efforts and resources to make the health reforms succeed. The convergence strategy aims to generate sufficient improvements in health delivery and financing in these local sites that are easily discernible by the residents. A strong support base of satisfied residents and their political representatives would make HSRA implementation irreversible. The DOH targeted the implementation of the health reform package in 64 convergence sites by 2004. When government changed in early 2001, the new DOH leadership continued the reform program, and used Tulong-Sulong Sa Kalusugan (TSK) as its communication handle. TSK was successfully and effectively used as the slogan for implementing the convergence strategy of HSRA.